Antibiotics for the Prevention and Treatment of Postsurgical Obstetric Infections. Issue 8 (August 2018)

• Record Type: Journal Article
• Authors: DeNoble, Anna E.; Kuller, Jeffrey A.; Phillips Heine, R.; Dotters-Katz, Sarah
• Is Part Of: Obstetrical & gynecological survey. Volume 73:Issue 8(2018)
• Publication Date: 2018-08
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; Generative organs, Female -- Surgery -- Periodicals; 618
• DOI: 10.1097/OGX.0000000000000590
• Languages: English
• ISSNs: 0029-7828

Abstract

Abstract : Importance: Infectious complications contribute significantly to maternal morbidity and mortality. Antibiotics are a cornerstone of prevention and management of postsurgical infections in obstetrics. However, antibiotic resistance from inappropriate use of antibiotics is an emerging global health threat. Objective: The aim of this study was to review the evidence and provide recommendations for antibiotic selection for prevention and treatment of postsurgical infections in obstetrics. Evidence Acquisition: Published literature was retrieved through a search of PubMed. Relevant original research articles, systematic reviews, review articles, and practice guidelines were identified and included. Results: Available evidence supports the use of a first-generation cephalosporin for an unlabored cesarean delivery, with the addition of adjunctive azithromycin for women undergoing labored cesarean delivery. Limited data also support the use of a second-generation cephalosporin at the time of obstetric anal sphincter injury repair. Limited retrospective studies suggest against the use of prophylactic antibiotics for manual removal of the placenta. Data are insufficient to recommend prophylactic antibiotics for postpartum dilation and curettage. Evidence from a systematic review supports clindamycin and gentamicin as the optimal regimen for the treatment of postpartum endometritis. Original obstetric research for the treatment of other postsurgical obstetric infections is limited, and recommendations provided are based on expert opinion. Conclusions and Relevance: Obstetric providers should be familiar with available evidence and guidelines regarding antibiotic selection for the prevention and treatment of obstetric infections. Widespread selection of the narrowest effective antibiotic regimen has the potential to combat the rising threat of antibiotic resistance while ensuring appropriate prevention and treatment of postsurgical infections in obstetrics. Target Audience: Obstetricians and gynecologists, family physicians. Learning Objectives: After completing this activity, the learner should be better able to (1) categorize the most common bacterial isolates responsible for obstetric postsurgical infections; (2) determine which obstetric operative interventions warrant antibiotic prophylaxis based on evidence-based guidelines; and (3) select appropriate, effective, and targeted antibiotics for the treatment of postsurgical infections in obstetrics patients.